Health Library Ear Problems and Injuries, Age 12 and OlderFrom Healthwise

Ear problems may be caused by many different health problems. In children, ear pain is more likely to be a symptom of an inflammation, infection, or fluid buildup in the external or middle ear. But ear pain at any age may be a symptom of:

• Infection of the middle ear (acute otitis media).
• Inflammation or infection of the ear canal (otitis externa).
• Buildup of fluid behind the eardrum (otitis media with effusion), without infection.

Ear problems caused by an injury to the ear can occur at any age. Common injuries include the following:

• A fall or a forceful, direct blow to the side of the head can burst the eardrum or damage the tiny bones in the inner ear that send sound to the brain.
• Loud noises or explosions can damage the eardrum (acoustic trauma).
• Atmospheric pressure changes (barotrauma) can cause problems with the eustachian tube and trap air in or keep air out of the middle ear. Middle ear problems can be severe (for example, the ear drum can burst or the middle ear can fill with blood or pus) or mild and only be felt as changes in pressure.
• Cuts or scrapes may injure the outside of the ear or ear canal. For more information, see the topic Ear Canal Problems (Swimmer's Ear).
• Cleaning the ear canal too often, too forcefully, or with a cotton swab, bobby pin, or sharp fingernail can cause irritation or injury.
• Burns or frostbite can cause ear injuries (thermal injuries).
• Objects placed in the ear can cause injury to the ear canal or the ear drum (tympanic membrane).

Hearing loss often comes with age. As people get older, ear problems are more likely to be related to:

• Heredity. The age of onset and how quickly the hearing loss progresses can often be determined by studying family members with hearing loss.
• The buildup of earwax. For more information, see the topic Earwax.
• Exposure to loud noises, such as setting off an air bag during a car crash, machines at work, power tools, gunshots, or loud music.
• Other serious medical problems, such as Ménière's disease or an acoustic neuroma.
• Skin reaction (dermatitis) on the outside of the ear or in the ear canal from perfume, hair dye, or wearing hearing aids.

The ear shares nerves with other parts of the face, eyes, jaw, teeth, and upper neck. Pain that feels as if it is in the ear may be coming from another part of the head or neck. This is called referred ear pain and is more common in older adults. Causes of referred ear pain can include dental problems, jaw pain ( temporomandibular disorder), or a sinus infection.

Review the Check Your Symptoms section to determine if and when you need to see a doctor.

• Sudden hearing loss occurs with other symptoms, such as:
  • Facial droop.
  • Numbness or paralysis on all or one side of the face or body.
  • Eye or vision problems, including blurred or double vision or the inability to see out of one eye.
  • Slurred speech, inability to speak, or difficulty understanding speech.
  • Difficulty standing or walking (ataxia).
  • Severe nausea or vomiting.
  • Dizziness (vertigo).
  • Sudden ringing or buzzing in the ears (tinnitus).

If you answer yes to any of the following questions, click on the "Yes" in front of the question for information about how soon to see a health professional.

Review health risks that may increase the seriousness of your symptoms.

If you have the following symptom, evaluate that symptom first.

• Drainage from the ear occurs following a head injury: Go to the topic Head Injury, Age 4 and Older.

	Yes	Have you had an injury to your ear?
When to See a Doctor See significance of injury to the ear if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Have you had sudden, complete hearing loss? Yes Do you have severe pain? Yes Do you have severe dizziness that makes it hard to stand or walk? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have some hearing loss? Yes Do you have drainage or bleeding from the ear? Yes Do you have mild to moderate pain? Yes Do you have mild dizziness? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to any of the following questions. Yes Have you had symptoms for longer than 24 hours that have slowly gotten worse? Yes Have you had mild symptoms for longer than 1 week that have not gotten better? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you think you have an ear infection or other problems from an ear infection?
When to See a Doctor See significance of an ear infection or other problems from an ear infection if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Before you answer the questions below, rate the severity of your pain. Do not put anything (such as water, eardrops, or cotton swabs) into your ear unless your doctor tells you to. If you need information on how to take a temperature, see the topic Body Temperature. Call your health professional immediately if you answer "Yes" to any of the following questions. Yes Do you have severe ear pain? Yes Do you have ear pain with other symptoms of a serious illness? Yes Do you have a fever of 104 °F (40 °C) or higher? Yes Do you think you have a high fever but you are unable to measure your temperature? Yes Do you have ear pain and vertigo? Yes Have you developed ear pain and a sudden hearing loss? Yes Do you have diabetes? Yes Do you have a disease or take medicine that causes problems with your immune system? Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have moderate but increasing ear pain? Yes Do you have moderate ear pain and a fever? Yes Have you had a fever for longer than 48 hours, despite taking antibiotics? Yes Do you have moderate ear pain (like pain you have had with other ear infections)? Yes Have you had moderate ear pain for 12 hours or longer? Yes Do you have redness, swelling, or pain around or behind your ear? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Have you had mild ear pain and a fever 48 hours or longer? You need an appointment within the next 1 to 2 weeks if you answer "Yes" to any of the following questions. Yes Have you had ear pain for 2 weeks or longer? Yes Do you have itching of the ear or ear canal? Yes Do you have a feeling of fullness in the ear? Yes Has your hearing slowly gotten worse? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Have you had a sudden hearing loss?
When to See a Doctor See significance of sudden hearing loss if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to the following question. Yes Have you had new, sudden hearing loss without other symptoms? You may wait to see if the symptoms improve over the next 24 hours (or specified time period) if you answer "Yes" to the following question. Yes Do you still have hearing loss after 4 days of home treatment that you think is caused by earwax or fluid buildup? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you have drainage from your ear that you do not think is earwax?
When to See a Doctor See significance of drainage if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Note: Do not insert anything (such as water, eardrops, or cotton swabs) into the ear unless instructed to do so by your doctor. Call your health professional today if you answer "Yes" to any of the following questions. Yes Do you have pus or white, yellow, or bloody fluid draining from your ear? Yes Do you have bad-smelling fluid draining from your ear? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Do you still have symptoms after 48 hours of treatment with antibiotics?
When to See a Doctor See significance of treatment with antibiotics if you need information to help you answer the questions below. Review health risks that may increase the seriousness of your symptoms. Call your health professional today if you answer "Yes" to any of the following questions. Note: If you answer Yes to any of the following questions, call your doctor to discuss a possible change in medicine or reevaluation. An appointment may not be necessary. Yes Are your symptoms the same or worse after 48 hours of treatment with antibiotics? Yes Do you have redness, swelling, or pain behind or around the ear? Yes Do you have a new skin rash? Yes Do you have diarrhea? Yes Do you have nausea or vomiting that keeps you from taking fluids or your antibiotics? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.
	Yes	Has hearing loss come on slowly and not gotten better?
When to See a Doctor See significance of hearing loss that lasts longer than 2 weeks if you need information to help you answer the question below. Review health risks that may increase the seriousness of your symptoms. You need an appointment within the next 1 to 2 weeks if you answer "Yes" to the following question. Yes Have you had any hearing loss for longer than 2 weeks? If you have answered "No" to the above questions, continue to answer the questions to evaluate your symptoms.

Other Symptoms to Watch For

Do you have any of the following symptoms?

• An object in the ear: Go to the topic Objects in the Ear.
• Ringing in the ears: Go to the topic Ringing in the Ears (Tinnitus).
• Earwax: Go to the topic Earwax.
• Dizziness: Go to the topic Dizziness: Lightheadedness and Vertigo.
• A cut on or in the ear: Go to the topic Cuts.
• Frostbite of the outer ear: Go to the topic Cold Temperature Exposure.
• A burn to the outer ear: Go to the topic Burns.
• Skin changes on your ears: Go to the topic Skin Changes.

If a visit to a health professional is not needed immediately, see the Home Treatment section for self-care information.

Home treatment may be all that is needed to relieve minor or intermittent ear discomfort.

• To ease ear pain, apply a warm washcloth or a heating pad set on low. There may be some drainage from the ear when the heat melts earwax.
  • Do not use a heating pad when you are in bed; you may fall asleep and burn yourself.
  • Do not use a heating pad on a child.
• Try an ice or cold pack to reduce swelling from a minor injury or sunburn. Apply for 15 minutes 3 or 4 times a day during the first 48 hours after the injury. The sooner you apply a cold pack, the less swelling you are likely to have. Place a cloth between the ice and your skin.
• Oral or nasal decongestants may relieve ear pain, especially if the pain is related to fluid behind the eardrum ( otitis media with effusion). Avoid products that contain antihistamines, which tend to cause more blockage, unless allergies seem to be the problem.
• Chewing gum may help relieve pressure changes in the ear, such as when flying in an airplane.
• Try a nonprescription earwax remover if your ear feels plugged but you do not have obvious signs of infection. Be sure to follow the label directions carefully.
• Do not use ear candles. They have no proven benefit in the removal of earwax or the treatment of other ear problems, and they can cause serious injury.

Symptoms to Watch For During Home Treatment

Use the Check Your Symptoms section to evaluate your symptoms if any of the following occur during home treatment:

• Pain develops or increases.
• Fever or other signs of ear infection develop.
• New or different drainage from the ear develops.
• Other symptoms develop, such as hearing loss or dizziness.
• Your symptoms become more severe or frequent.

You may be able to prevent ear problems.

• Teach your children to blow their noses gently. Remember to do this yourself also.
• Keep soap and shampoo out of the ear canal. These products can cause itching, which can be mistaken for an ear infection because of the need to scratch or pull at the ears.
• Do not put cotton swabs, bobby pins, or other objects (especially if they are sharp) in the ear canal.
• Limit your contact with others who have colds, when possible.
• Protect your ears from sunburn and frostbite.
  • Apply sunscreen to your ears and wear a hat that shades the ears in the summer.
  • Wear a hat that covers the ears in the winter.
• Limit or avoid exposure to loud noises such as music, power tools, gunshots, and industrial machinery.
• Wear protective earplugs or earmuffs if you cannot avoid loud noises.
  • Avoid the prolonged use of earplugs. They can cause irritation, itching, and can plug the ear with wax.
  • Do not use wadded-up tissue or cotton balls. These do not protect adequately against loud noises (especially the more dangerous high frequencies) and they may become lodged in the ear canal.
• Avoid exposing children to cigarette smoke, which is associated with more frequent ear infections. If you smoke and are unable to stop, smoke outside, away from children.
• Stop smoking. Smoking irritates the mucous membranes that line the nose, sinuses, and lungs, and it may contribute to inflammation or infection of the ear. See the topic Quitting Tobacco Use.
• If ear pain appears to be related to a problem with your jaw, see the topic Temporomandibular (TM) Disorders for tips on relaxing the muscles in this area.
• Take good care of your teeth. Daily brushing and flossing, along with regular dental checkups, helps prevent tooth decay, infections, and other dental problems that can lead to referred ear pain.
• If you wear hearing aids, be sure to follow the manufacturer's recommendations carefully for cleaning and storing them.
• For tips on how to prevent swimmer's ear, see the topic Ear Canal Problems (Swimmer's Ear).

To prepare for your appointment, see the topic Making the Most of Your Appointment.

You can help your doctor diagnose and treat your condition by being prepared to answer the following questions:

• Do you have ear pain?
  • When did the pain start?
  • What were you doing when the pain started?
  • Does the pain come from the inside or the outside of your ear?
  • Has the pain been constant, or does it come and go?
  • Does anything make the pain better or worse?
• Have you ever had this type of ear problem before? If yes, what was the diagnosis and how was it treated?
• What other symptoms do you have? Do you have a fever, runny nose, cough, congestion, or jaw discomfort?
• Do you suspect a hearing problem? Be prepared to describe your symptoms.
  • Do you have hearing loss or ringing in the ears (tinnitus)?
  • Does your hearing problem affect just one ear or both ears?
• Do you use hearing aids?
• Have you had a recent injury to the ear?
• Do you have any other symptoms in your eye, teeth, jaw, facial muscles, or neck that might suggest referred pain?
• Do you have drainage from the ear? If yes, what does it look and smell like?
• Have you had problems with earaches or ear infections in the past?
• Have you been swimming or had other recent exposure to water, such as through surfing, kayaking, or scuba diving?
• Do you regularly use a hot tub or home spa?
• Have you recently traveled by plane?
• What home treatment measures have you used? Be sure to include nonprescription and prescription medicines you have tried.
• Do you have any health risks?

• Benign Paroxysmal Positional Vertigo (BPPV)
• Burns
• Cold Temperature Exposure
• Cuts
• Ear Canal Problems (Swimmer's Ear)
• Ear Infections
• Earwax
• Facial Problems, Noninjury
• Fever, Age 4 and Older
• Head Injury, Age 4 and Older
• Hearing Loss
• Labyrinthitis
• Ménière's Disease
• Objects in the Ear
• Quitting Tobacco Use
• Respiratory Problems, Age 12 and Older
• Ringing in the Ears (Tinnitus)
• Scrapes
• Sinusitis
• Sore Throat
• Strep Throat
• Temporomandibular (TM) Disorders
• Vestibular Neuritis

Author:	Jan Nissl, RN, BS	Last Updated: February 13, 2008
Medical Review:	William M. Green, MD - Emergency Medicine Donald R. Mintz, MD - Otolaryngology
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